Literature Review On Corticotomy

With increasing number of adult patients seeking orthodontic treatment, shorter treatment duration has become a common demand. Other than esthetics, lengthier orthodontic treatment also poses certain drawbacks like increased predisposition to dental caries, root resorption and decreased patient compliance. Hence every year there is increased demand for research in treatment based modalities for speedy yet effective way of orthodontic treatment by both patients and orthodontists. Bracket designs, customization and arch wire continued to evolve with intention to reduce the duration of orthodontic treatment. But then gradually it came to notice that they were not the only method to induce faster tooth movement. Pharmaceuticals agents, electromagnetics

They challenged the bony block concept and stated that cascade of transient localised reactions lead to accelerating orthodontic tooth movement. The designs of corticotomies and perforation was intended to maximize the trauma to alveolus and to promote ample bleeding. This dynamic healing process that occurred at the site of osseous injury was known as regional acceleratory phenomenon (RAP) in the orthopaedic literature. A recent publication has shown that this clearly is the phenomenon in maxilla and mandible as earlier studies were only on long bones. This technique included full thickness labial and lingual alveolar flaps with decortications that did not reach the medullary bone. They defined their approach as “accelerated oeteogenic orthodontics” (AOO) which demonstrated acceleration of treatment to one third of usual time. In 2007 Vercelloti and Pedosta27 used this technique along with piezosurgery. Although they were highly effective and predictable but with it they were vastly invasive too because of extensive flap elevations, post surgical complications and discomfort was

In this a reinforced scalpel and a mallet to go through gingival and cortical bone was used without raising flap. This technique although innovative had two drawbacks: firstly the inability to graft soft or hard tissues during procedure to correct inadequacies and reinforce the periodontium and secondly repeated malleting caused dizziness after surgery.
In 2009 Dibart et al proposed a new and minimally invasive procedure that was called ‘piezocision’. This approach combines microincisions to the buccal gingival that allows for the use of piezoelectric knife to decorticate the alveolar bone to initiate the RAP. It has the advantage of allowing hard tissue or soft tissue grafting via selective tunnelling to correct gingival recession or bone deficiencies in patients and also in spite of being more conservative approach towards surgery it induces more extensive and diffuse demineralization followed by increased remineralization effect on the bone. It is due to the microvibrations created by piezotome which has an additive effect on oseteocytes.
Hence the piezocision technique has the unique advantage of minimally invasion with opportunity for hard and soft tissue grafting. This technique needs to be explored more as we have mainly case reports and very less clinical